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Oxycodone vs. Hydrocodone for Pain Relief

A side-by-side review

Oxycodone and hydrocodone are prescription pain medications. Both can treat short-term pain caused by an injury or surgery. They may also be used to treat pain that is chronic, or long-term. Additionally, each may also be prescribed to treat other conditions, including chronic cough, pain from cancer, and arthritis.

Both types of medicines can be taken alone. You may also find combination versions of each drug. For example, acetaminophen may be added to oxycodone to make a specific narcotic analgesic. This type of combination medicine can calm a person’s mood, which gives the painkiller time to work. Hydrocodone is often combined with antihistamines to create a syrup that suppresses the cough reflex and provides relief from pain associated with coughing.

Hoping to avoid medications? Try these natural options »

Oxycodone and hydrocodone

Oxycodone and hydrocodone are powerful narcotic painkillers. Both are available only with a prescription from your doctor. Both interfere with your central nervous system’s pain signals. They prevent the nerves in your body from sending pain signals to your brain.

The differences between the two are primarily in the side effects they cause.

Who they’re for

Oxycodone is used to treat moderate to severe pain. Patients who take the medication usually do so on an around-the-clock basis until the doctor ends their prescription or tells them to stop taking the medicine. In other words, oxycodone should not be taken on an as-needed basis the way you would take over-the-counter pain medicine.

Hydrocodone is also used to treat moderate to severe pain caused by a chronic condition, injury, or surgery. Like oxycodone, it should only be taken as prescribed by your doctor. This is important because of the risk of addiction. Perhaps because of the way it's prescribed, hydrocodone appears more likely to cause dependency than oxycodone. It is abused more than any other opioid in the United States, while in many European countries hydrocodone has been highly restricted for many years.

Drug class and how that class works

Until the fall of 2014, hydrocodone and oxycodone were in two different drug schedules. A drug schedule is a number that is assigned to a medicine, chemical, or substance. The schedule number indicates the likelihood the substance could be abused, as well as the drug’s accepted medical use.

Today, both hydrocodone and oxycodone are schedule II drugs. Schedule II drugs have a high potential for being abused.

Forms and dosing

Frequently both oxycodone and hydrocodone are combined with other painkillers or chemicals. Pure oxycodone is available in a brand name medicine called Oxycontin.

Oxycontin is available as a tablet you take orally usually every 12 hours. The tablets are available in several different doses. The dose you use depends on the severity of your pain.

Pure hydrocodone is available in an extended-release form. The brand name for the medicine is Zohydro ER. You can take an extended-release (controlled release) tablet orally every 12 hours. This medicine is designed to release into your body slowly, not all at once. This allows the medicine to work over a long period of time. This medicine can also be used to treat long-term pain problems.

Effectiveness

Both oxycodone and hydrocodone are powerful painkillers, and they have been shown to be highly effective at treating pain.

In the event of an emergency situation, researchers have found the two medicines treat pain equally. In a study with both drugs, researchers found that both oxycodone and hydrocodone were equally effective at treating pain caused by fractures. Patients experienced equal pain relief 30 and 60 minutes after the medicine was taken. However, patients who were given hydrocodone experienced constipation more frequently than patients who used oxycodone.

Another study found that the combination of oxycodone and acetaminophen (another type of painkiller) was 1.5 times more potent than hydrocodone with acetaminophen when taken at equal doses.

Cost

Both oxycodone and hydrocodone are sold as brand name drugs and as generic alternatives. Generic medications are cheaper than their brand name counterparts. For that reason, you may wish to try the generic.

Before you do that, consult your doctor. Some generic versions of medicines have different ratios of active and inactive ingredients. To be classified as generic by the FDA, the drug must include the same strength of active ingredients, but may not have the same amount of inactive ingredients.

If you need to use the brand name but find that the price tag is too high, prescription drug insurance and prescription coupons may help reduce your total cost. Talk with your pharmacist about the savings you’re eligible to receive.

Side effects

The most common side effects of oxycodone and hydrocodone are similar. These side effects include:

  • shallow or light breathing
  • drowsiness
  • dizziness
  • nausea
  • vomiting
  • lethargy
  • dry mouth
  • itching
  • motor skill impairment

Hydrocodone is more likely to cause constipation and stomach pain.

Severe, though less common side effects include:

  • seizures
  • feeling like you might pass out
  • rapid heart beat (leading to a possible heart failure)
  • painful urination
  • confusion

Warnings and interactions

Do not use these powerful pain medications without first consulting with your doctor about your health history and any pre-existing conditions you have.

People who have asthma or breathing difficulties may need to avoid these pain medications entirely. Also, because of the risk of increased constipation, people who have blockages or difficulty with constipation may not want to take hydrocodone.

Do not take these medications if you have kidney or liver disease. These drugs can make these conditions worse. Additionally, do not drink alcohol while taking these medications. The combination of alcohol and painkillers can be deadly. You may experience extreme dizziness or drowsiness. The combination can also damage your liver.

If you are pregnant, talk with your doctor about the risks of these medications while you’re expecting. A study published in the American Journal of Obstetrics and Gynecology found that there was an association between opioid treatment and certain birth defects. Also, some of the side effects of the medication could cause problems for you while you are pregnant. These side effects include behavior changes, difficulty breathing, constipation, and lightheadedness.

If you are breastfeeding, do not take these medications. The medicine can pass through breast milk and harm your baby.

Even at low levels and when taken exactly as prescribed, these medications can be habit-forming. Misuse of these narcotics can lead to addiction, poisoning, overdose, or even death. Do not leave these pills in a place where children could reach them.

Which medicine should you choose?

Both hydrocodone and oxycodone are effective at easing acute and chronic pain. They both cause very similar side effects. The differences between the two drugs are minimal, so the best way to pick which drug is right for you is by having a conversation with your doctor.

Based on your personal medical history, your doctor can weigh the pros and cons of the two medications. Some researchers and medical professionals find that hydrocodone is less powerful compared to oxycodone. In that case, your doctor may prefer to start you on a smaller dose to see how your body handles the medication.

If the first option you try does not work or causes adverse side effects, you and your doctor can talk about changing medications or doses to find something that works for you.

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